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At least 109 records · Page 6Linked to original sources
PubMed2003

A prospective assessment of diagnostic efficacy of blind protective bronchial brushings compared to bronchoscope-assisted lavage, bronchoscope-directed brushings, and blind endotracheal aspirates in ventilator-associated pneumonia.

BACKGROUND: The purpose of this study is to compare techniques for the diagnosis of suspected ventilator-associated pneumonia in the trauma patient. Per the literature, bronchoscope protected brushings and bronchoalveolar lavage were set as the standards for comparison because of their high specificity and sensitivity. We hypothesized that blind protected brushings were equivalent to bronchoscope-directed techniques and that endotracheal aspirates (ETA) were not. METHODS: With informed consent, 90 trauma patients with two or more of the following were accepted into the study: 48 hours or more on the ventilator, new or increasing infiltrate on chest radiograph, excess or purulent secretions, suspected aspiration, temperature of 38.5 degrees C or above, white blood cell count greater than or equal to 12,000/mm3, and respiratory distress. Four samplings were performed on each patient using bronchoscope-assisted and nonbronchoscopic techniques. Each patient had cultures obtained by and significances quantified as follows: ETA, moderate/many/abundant; bronchoscope-directed protected brushings (BDPB), 103 colony-forming units [CFU]/mL; blind protected brushing via endotracheal tube (BPB), 103 CFU/mL; and bronchoscopic bronchoalveolar lavage (BAL), 104 CFU/mL. Quantitative cultures were obtained and compared for the following pathogens: gram-positive cocci, gram-positive rods, gram-negative cocci, gram-negative rods, anaerobic bacteria, and yeast. An assessment of agreement for cultured pathogens between the sampling modalities was completed using kappa (kappa) analysis, and significance was set at p < or = 0.05. RESULTS: With patients used as their own controls, Gram's stain and pathogens cultured from the various sampling techniques were compared for agreement by kappa analysis. BDPB and BAL were set as the "gold standards" for comparison against each other and against the BPB and ETA. Kappa analysis was used to measure the strength of agreement for these findings; individual values from the comparisons of Gram's stain were then averaged for descriptive purposes of the data. Most kappa values were associated with a statistically significant value of p < 0.05. The greatest strength of agreement was found to be moderate comparing Gram's stain results of BPB and BDPB (kappa = 0.467), ETA and BAL (kappa = 0.535), and BPB and BAL (kappa = 0.547). Fair kappa values were shown in comparing Gram's stain results of ETA and BDPB (kappa = 0.382) and BAL and BDPB (kappa = 0.390). CONCLUSION: A quantitative analysis of bacteriologic cultures obtained by four standard sampling techniques has demonstrated with statistical significance that no difference exists between modality of sampling in reliability or in obtaining clinically significant pathogens. In reviewing the literature, this study is the first assessment of agreement for cultured pathogens between the four different sampling modalities and the largest to assess the efficacy of the blind protected brush technique.

Bronchoalveolar Lavage Fluid↗
PubMed1976

Spirometric comparison of carbuterol and isoproterenol aerosol therapy in bronchial asthma. A double blind, matched-pair study of 28 adults and a double blind crossover study of 18 children.

Two adrenergic aerosols were compared in a double blind, matched-pair study of 6 months' duration in 28 adult patients with chronic bronchial asthma, and in a double blind, crossover, short-term study in 18 children with severe asthma. In the adult study, one member of each pair was given either 150 mug of isoproterenol or 200 mug of carbuterol 4 times per day, by inhalation, for 6 months. In the childhood study, 18 children, 6 to 12 years of age, with moderate to severe asthma were studied in a double blind, crossover therapeutic trial in which high or low doses of aerosolized carbuterol or isoproterenol were given 4 times daily for 5 days each. Treatment results were evaluated by measuring forced vital capacity, 1-sec forced expiratory volume, and maximal mid-expiratory flow (FEF25-75%) at regulat intervals before and after administration of the respective test drugs. In the adult study, there was a significant difference between carbuterol and isoproterenol for forced vital capacity (P less than 0.02), for 1-sec forced expiratory volume (P less than 0.02), and for FEF25-75% (P less than 0.01) in favor of carbuterol. In the pediatric study, the difference between carbuterol and isoproterenol was significant (P less than 0.05) only for the FEF25-75% on the fifth day of treatment with the high dose administration of carbuterol. There was no associated toxicity of either drug with respect to electrocardiogram, blood chemistry, or subjective complaints. Tachyphylaxis (tolerance with time) to isoproterenol appeared to develop in one patient.

Adrenergic beta-Agonists↗
PubMed2004

Circadian genes in a blind subterranean mammal III: molecular cloning and circadian regulation of cryptochrome genes in the blind subterranean mole rat, Spalax ehrenbergi superspecies.

The blind subterranean mole rat superspecies Spalax ehrenbergi is an extreme example of mammalian adaptation to life underground. Though this rodent is totally visually blind, harboring a drastically degenerated subcutaneous rudimentary eye, its daily activity rhythm is entrainable to LD cycles. This indicates that it confers light information to the clock, as has been previously shown by the authors in behavioral studies as well as by molecular analyses of its Clock/MOP3 and its three Per genes. The Cryptochrome (Cry) genes found in animals and plants act both as photoreceptors and as essential components of the negative feedback mechanism of the biological clock. To further understand the circadian system of this unique mammal, the authors cloned and characterized the open reading frame of Spalax Cry1 and Cry2. The Spalax CRY1 protein is significantly closer to the human homolog than to the mice one, in contrast to the evolutionary expectations. They have found two isoforms of Cry2 in Spalax, which differ in their 5' end of the open reading frame and defined their expression in Spalax populations. They found a large and significant excess of heterozygotes of sCry2 (sCry2L/S genotype). Both sCry1 and sCry2 mRNAs were found in the SCN, the eye, the harderian gland, as well as in a wide range of peripheral tissues. Their expression pattern under different LD conditions has also been analyzed. As was already shown for other circadian genes, despite being blind and living in darkness, the Cry genes of Spalax behave in a similar, though not identical, pattern as in sighted animals. Once again, the results indicate that the uniquely hypertrophied harderian gland of Spalax plays a key role in its circadian system.

Amino Acid Sequence↗
PubMed1992

Prospective randomized open blinded end-point (PROBE) study. A novel design for intervention trials. Prospective Randomized Open Blinded End-Point.

A novel design for intervention studies is presented, the so called PROBE study (Prospective Randomized Open, Blinded End-point). This design is compared to the classical double-blind design. Among the advantages of the PROBE design are lower cost and greater similarity to standard clinical practice, which should make the results more easily applicable in routine medical care. Since end-points are evaluated by a blinded end-point committee it is obvious that there should be no difference between the two types of trials in this regard.

Blood Pressure↗
PubMed1991

[Blind ending bifid ureter with stone in the blind branch: report of a case].

Blind ending bifid ureter is a rare anomaly in the urinary tract. This anomaly may result from failure of a premature branch of the ureteral bud to join with the metanephric blastema. A 21-year-old man was admitted with macroscopic hematuria and colic pain in the left flank region. Urinalysis demonstrated hematopyuria and excretory urography suggested bifid ending accessory ureter with a stone on the left side. Surgical exploration showed that the accessory ureter was bifurcated from the left ureter at about 5 mm from the bladder wall and ran parallel with the left ureter. Although dense adhesions to the surrounding tissue existed, the accessory ureter was resected at the site of the junction. It measured 3 cm in length and 1 cm in greatest diameter. The stone found at the tip of the accessory ureter was composed of calcium oxalate (24%) and calcium phosphate (76%). Histological examination revealed that the ureter had all layers of normal ureteral structure and no renal tissue was identified in the specimen resected. During a follow-up period of 22 months after the operation, he was free of urinary tract infection and abdominal pain. Of 77 cases with blind ending bifid ureter reported in the Japanese literature, a ureteral stone was found in the blind branch in only 5 cases.

Adult↗
PubMed1979

Double-blind and triple-blind assessments of medication and placebo responses in hyperactive children.

Hyperactive boys taking psychostimulant medication were studied using a randomized, placebo-controlled, crossover design. Behavior ratings and medication guesstimates were obtained for the boys when they were given methylphenidate (Ritalin) and when they were given a placebo. The ratings showed positive medication-related changes, and the guesses, done by independent judges, were significantly better than chance. The pattern of ratings for double-blind and triple-blind raters was identical. These results imply that positive psychostimulant effects are not attributable to rater sensitization or expectancy. The medication-placebo differences were highly reliable for the group comparisons and were in the predicted direction for 21 of 22 individuals, but the magnitude of the change for many individuals was not dramatic. Implications for child psychopharmacology research and differences between clinical and experimental significance are discussed.

Child↗
PubMed1975

Blindness in Mentally Retarded Children. A survey of the causes of blindness in 201 notified patients.

A preliminary survey of the causes of blindness in mentally retarded children in Denmark showed that 50% of the children had optic atrophy, 12.5% had cataract while tapeto-retinal degenerations, other malformation and retrolental fibroplasia each represents 8-9% of the causes of blindness. The survey, was done through written notification and some patients with tapeto-retinal degenerations might have been wrongly diagnosed.

Blindness↗
PubMed1998

Antithrombin III in patients with severe sepsis. A randomized, placebo-controlled, double-blind multicenter trial plus a meta-analysis on all randomized, placebo-controlled, double-blind trials with antithrombin III in severe sepsis.

OBJECTIVES: To evaluate the safety and potential efficacy of antithrombin III (AT III) in reducing mortality in patients with severe sepsis. DESIGN: Prospective, randomized, placebo-controlled, double-blind, phase II, multicenter, multinational clinical trial. SETTING: Seven academic medical center intensive care units (ICU) in Belgium, Denmark, the Netherlands, Norway and Sweden. PATIENTS: 42 patients with severe sepsis who received standard supportive care and antimicrobial therapy, in addition to the administration of AT III or placebo. INTERVENTIONS: Patients received either an intravenous loading dose of 3000 IU AT III followed by a maintenance dose of 1500 IU every 12 h for 5 days or equivalent amounts of placebo. MEASUREMENTS AND RESULTS: All patients were evaluated for safety and for 30-day all-cause mortality. CONCLUSIONS: The administration of AT III was safe and well-tolerated. It was followed by a 39 % reduction in 30-day all-cause mortality (NS). The reduction in mortality was accompanied by a considerably shorter stay in the ICU. Patients treated with AT III exhibited a better performance in overall severity of illness and organ failure scores (Acute Physiology and Chronic Health Evaluation II, multiple organ failure, organ system failure), which was noticeable soon after initiation of treatment. Patients treated with AT III demonstrated a better resolution of pre-existing organ failures and a lower incidence of new organ failures during the observation period. A meta-analysis comprising this and two other double-blind, placebo-controlled trials with AT III with a total of 122 patients suffering from severe sepsis confirms the positive trend. The results of the meta-analysis demonstrate a 22.9 % reduction in 30-day all-cause mortality in patients treated with AT III. Although still too small to be confirmative, the meta-analysis clearly points to the fact that a sufficiently powered phase III trial is warranted to prove whether AT III has a beneficial role in the treatment of severe sepsis.

APACHE↗
PubMed1991

A combined single-blind, double-blind, placebo-controlled study to determine the reproducibility of hypersensitivity reactions to aspartame.

Aspartame is an O-methyl ester composed of phenylalanine and aspartic acid. After its final approval as a sweetener in 1981, a number of reports of adverse reactions to aspartame appeared in the literature. To explore the pathogenesis of such reactions, we initiated a study in July 1986 to identify subjects with hypersensitivity reactions to aspartame with blinded challenge procedures. The study was closed after 32 months. During that time, we advertised in local newspapers and worked closely with the local community of allergists and dermatologists in an attempt to recruit subjects with hypersensitivity reactions to aspartame. A total of 61 self-referrals and physician referrals were screened, with 20 referrals evaluated in clinic. After this evaluation, 12 patients underwent single- and double-blind challenge with up to 2000 mg of aspartame. No subject with a clearly reproducible adverse reaction to aspartame was identified. In summary, we found that it is difficult to recruit study subjects with a history of hypersensitivity reactions to aspartame and that subjects who believed themselves allergic to aspartame did not have reproducible reactions.

Adult↗
PubMed1992

Changes in the DC electroretinogram in Briard dogs with hereditary congenital night blindness and partial day blindness.

Five Briard dogs, 7-12 months old, with congenital night blindness and severely reduced day vision (offspring of a sister and brother with congenital and supposedly stationary night blindness but with normal or nearly normal day vision) and three normal control dogs were studied by means of direct current (DC) electroretinography in order to analyse fast and slow retinal and pigment epithelial (RPE) potentials. No definite a- and b-waves were seen in the affected dogs in the dark-adapted state, which indicates severely impaired rod function. All affected dogs responded to 30 Hz flickering light in the light-adapted state, although with an amplitude reduced by 50-70%. Thus, cone function was better preserved than rod function. The control dogs showed a small c-wave and a deep negative trough between the b- and c-waves, indicating that slow PIII from the Müller cells, as well as the photoreceptor potential, are very prominent. In the affected dogs, there was no c-wave, but from a stimulus intensity of 3 log U above the normal b-wave threshold, a slow negative potential appeared, the latency and peak time of which were very long, 5-7 and 11-15 sec, respectively. With increasing stimulus intensities, both parameters decreased substantially, whereas the amplitude increased to a maximum of 2400 microV. In the light-adapted state, the dog with the best day vision showed a negative potential of short duration (peak time about 0.2 sec), followed by a positive potential (peak time about 1.2 sec).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2002

Blinding effectiveness and association of pretreatment expectations with pain improvement in a double-blind randomized controlled trial.

Patient, provider, and clinical investigator expectations concerning treatments are believed to play important roles in patient response. This study examined the association of patient and research nurse/physician pretreatment expectations of pain relief with actual pain relief, the accuracy of patient and research nurse guesses about patient medication assignment, and changes in research nurse and patient pain relief expectations over the course of a randomized double-blind trial of amitriptyline versus an active placebo for patients with chronic pain and spinal cord injuries (SCI). Patient expectations of pain relief with amitriptyline were associated significantly with actual pain decrease for patients in the amitriptyline, but not placebo, condition. Research nurse/physician expectations did not predict patient pain relief. Both patients and the research nurse were able to guess patient medication assignment at a rate significantly greater than chance. The research nurse's, but not the patients', expectations of pain relief with amitriptyline decreased significantly over the course of the study. These findings have implications for future randomized controlled trials. Fully double-blind conditions are very difficult to achieve, and it is informative to assess patient and research clinician expectations and guesses regarding medication assignment.

Adult↗
PubMed1982

How blind was the patient blind in AMIS?

The Aspirin Myocardial Infarction Study (AMIS) was a double-blind placebo-controlled trial to test the effect of aspirin on the survival of 4524 people who had experienced a prior heart attack. Shortly before their closeout visits, 400 of the participants were randomly selected to be interviewed concerning their perceptions of their treatment assignments; 380 were actually interviewed. A bare majority (52)% correctly identified their study therapy, 28% mistakenly named the alternative treatment, 13% declined to guess, and 7% specified extraneous substances. According to the proposed formula for evaluating the patient blind, only 24% of the sample made "informed" guesses regarding their therapy, while the remainder guessed in an uninformed way or not at all. Those who tested their capsules (usually be taste) showed proportionately more correct responses than the nontesters. Correctness also varied with the reasons for the subjects' guesses (e.g., side effects). Among the sample as a whole, most people were only moderately or less than moderately certain their guess was correct. Even among those who were in fact correct, only 18% were absolutely certain of their choice.

Adult↗
PubMed1986

Causes of blindness in Australia: analysis of pensions granted by the Department of Social Security on the ground of blindness for the year ending 30 June 1984.

The principal and contributing causes of blindness for all pensions granted by the Department of Social Security on account of blindness in Australia during the year ending 30 June 1984 have been coded according to the International Classification of Diseases, 1975 (ICD9). The results are presented in tables which show the major diagnosis for symmetrical and asymmetrical cases according to frequency and age, and the combination of major and contributing diagnosis according to age, sex and prevalence per 100 persons.

Australia↗
PubMed1991

Visual disability and major causes of blindness in NSW: a study of people aged 50 and over attending the Royal Blind Society 1984 to 1989.

Visual disability in individuals aged 50 years and over seeking services of the Royal Blind Society in the years 1984 to 1989, was studied with respect to changes in frequency of major causes together with age and sex of those affected. The results mirror statistics in the UK. Age-related macular degeneration (AMD) accounts for an increasing proportion of visual disability (34% in 1984 to 43% in 1989). Of particular interest was the frequency of disability attributed to cataract. While decreasing (24% in 1984 to 19% in 1989), cataract still represents a significant cause of potentially treatable disability. The authors conclude that there is a changing prevalence of visual disability caused mainly by an increase in AMD and a subgroup of patients attending for services who appear to have a potentially remediable disability. These conclusions affirm the need for close liaison between ophthalmological practitioners and agencies for the blind.

Aged↗
PubMed2002

Local warming and insertion of peripheral venous cannulas: single blinded prospective randomised controlled trial and single blinded randomised crossover trial.

OBJECTIVE: To determine whether local warming of the lower arm and hand facilitates peripheral venous cannulation. DESIGN: Single blinded prospective randomised controlled trial and single blinded randomised crossover trial. SETTING: Neurosurgical unit and haematology ward of university hospital. PARTICIPANTS: 100 neurosurgical patients and 40 patients with leukaemia who required chemotherapy. INTERVENTIONS: Neurosurgical patients' hands and forearms were covered for 15 minutes with a carbon fibre heating mitt. Patients were assigned randomly to active warming at 52 degrees C or passive insulation (heater not activated). The same warming system was used for 10 minutes in patients with leukaemia. They were assigned randomly to active warming or passive insulation on day 1 and given alternative treatment during the subsequent visit. MAIN OUTCOME MEASURES: PRIMARY: success rate for insertion of 18 gauge cannula into vein on back of hand. SECONDARY: time required for successful cannulation. RESULTS: In neurosurgical patients, it took 36 seconds (95% confidence interval 31 to 40 seconds) to insert a cannula in the active warming group and 62 (50 to 74) seconds in the passive insulation group (P=0.002). Three (6%) first attempts failed in the active warming group compared with 14 (28%) in the passive insulation group (P=0.008). The crossover study in patients with leukaemia showed that insertion time was reduced by 20 seconds (8 to 32, P=0.013) with active warming and that failure rates at first attempt were 6% with warming and 30% with passive insulation (P<0.001). CONCLUSIONS: Local warming facilitates the insertion of peripheral venous cannulas, reducing both time and number of attempts required. This may decrease the time staff spend inserting cannulas, reduce supply costs, and improve patient satisfaction.

Arm↗
PubMed2003

Intravitreal triamcinolone acetonide injection in blind painful eyes. Intraocular steroids as a treatment for blind painful red eyes.

PURPOSE: Phthisis bulbi results from different ocular conditions. We evaluated intravitreal triamcinolone acetonide as a treatment option in blind painful eyes. METHODS: Thirty-one patients with unilateral phthisis were randomly divided into two groups. Group A received 0.3 ml (12.5 mg) triamcinolone acetonide intravitreally and Group B 0.3 ml balanced salt solution after retrobulbar anesthesia. Treatment success was assessed by subjective response to pain and clinically by biomicroscopic evaluation of conjunctival congestion. Tonometry was done before and after treatment. Follow-ups were at 24 hours, 3 weeks, 3 and 6 months, and 1 and 2 years. RESULTS: Throughout the two-year follow-up, only two patients in Group A reported pain after the procedure and were retreated, one at week 4 and the other at week 7. Conjunctival congestion was significantly lower in Group A. Two patients with hypotony before treatment had normal tension after triamcinolone. All Group B patients were reinjected with triamcinolone because pain continued after balanced salt solution injection. No severe complications were found. CONCLUSIONS: Intravitreal triamcinolone acetonide may be effective and safe for treating blind painful eyes.

Adolescent↗
PubMed1975

Causes of blindness in children. 1046 cases registered with the Canadian National Institute for the Blind 1970-1973.

During the period 1970-73, 1,046 children under 20 years of age were registered with the Canadian National Institute for the Blind. The three most common registration diagnoses were Cataract (13%), Optic Atrophy (12%) and Nystagmus (10%); Retrolental Fibroplasia was responsible for a smaller proportion (6%). Twenty per cent of the registration diagnoses were non-specific and included "Nystagmus", "Site or Type not Established", "Affection of Visual Centre" and "Amblyopia". Without a specific diagnosis one could not decide whether the blindness was due to genetic or environmental causes. It is recommended that the C.N.I.B. establish a procedure by which children with a non-specific registration diagnosis can be referred for further investigation.

Adolescent↗